2.2 Cardiometabolic screening
LP(A) and APOB
Adding Lp(a) and ApoB to a standard lipid panel (measured with an immunological assay) can significantly improve risk assessment and reduce cardiovascular disease (CVD) events, especially in individuals with “normal” cholesterol.
ApoB
ApoB is a superior predictor of CVD events compared to LDL-C, especially relevant for the 20% of patients with high triglycerides, diabetes, or obesity who may have a high number of small, dense LDL particles despite having a normal LDL-C level. For these individuals, measuring ApoB can uncover a hidden risk that would otherwise be missed. By identifying these high-risk individuals, healthcare providers can initiate more aggressive lipid-lowering therapy and lifestyle interventions, directly leading to a reduction in future CVD events.
Lp(a)
Lp(a) is a causal, independent, and genetically determined risk factor for CVD that affects about 20-25% of the population – if elevated it is associated with a significant increase in risk for heart attack, stroke, and aortic valve stenosis. Specifically, an elevated Lp(a) level can increase a person’s heart disease risk by up to 42% (Wong et al., 2024). For patients with an elevated Lp(a) level, while there are currently no widely available therapies, aggressively managing other modifiable risk factors (like LDL-C, blood pressure, and smoking) is crucial for mitigating this genetic risk.